Thrombolysis in acute ischaemic stroke: an update

Area of Science:

• Neurology
• Cardiovascular Medicine
• Emergency Medicine

Background:

• Stroke remains a leading cause of death and disability worldwide.
• Thrombolysis has revolutionized acute ischemic stroke management.
• Intravenous alteplase is the current standard thrombolytic therapy.

Purpose of the Study:

• To summarize recent advances in thrombolysis for acute ischemic stroke.
• To address key clinical decision-making questions regarding thrombolysis.
• To provide evidence-based answers for clinicians.

Main Methods:

• Review of current literature and clinical trial data on thrombolysis.
• Analysis of factors influencing thrombolysis efficacy and safety.
• Evaluation of extended time windows and patient selection criteria.

Main Results:

• The licensed thrombolysis window is 3 hours, extendable to 4.5 hours with proven benefit.
• Intracranial hemorrhage is a major complication, influenced by age, hypertension, diabetes, and stroke severity.
• Evidence for thrombolysis in patients over 80 years is limited but suggests no overt harm.
• Advanced imaging may enable future time window extensions.
• Transcranial Doppler ultrasound may enhance reperfusion rates.
• Intra-arterial thrombolysis shows no clear advantage over intravenous administration.

Conclusions:

• Thrombolysis is a critical treatment for acute ischemic stroke, with ongoing research expanding its application.
• Careful patient selection and risk-benefit assessment are essential, especially in specific patient groups.
• Further research is needed for thrombolysis in underrepresented populations and specific stroke etiologies.